Across the country, small regulations about the length of hallways and requirements about transforming clinics into mini-hospitals have shuttered providers and blocked access to safe abortion care to hundreds of thousands of women. In such a climate, the look and feel of a clinic -- how the built environment and aesthetic quality of the space can shape the patient experience, for example -- almost seems like an afterthought. When the fight is about keeping the doors open and the lights on, the possibility that a clinic might be beautiful as well as functional can feel a bit audacious.
But not to the women and men who work in our clinics or the patients they serve. And not to Lori Brown, an associate professor of architecture at Syracuse University who is currently working to transform the facade of Mississippi's last abortion clinic into something safe, functional -- and extraordinarily beautiful.
The Jackson Women's Health Organization is already a dazzling pink, and clinic owner Diane Derzis and clinic director Shannon Brewer-Anderson have invested a lot of time, resources and thought into making the clinic feel safe and welcoming to the women they serve. But the clinic is surrounded by a wide fence to keep out a regular collection of protesters. And in order to provide additional protection and privacy to patients and the people who work there, the fence is woven through with a thick black tarp. The impression from outside is something like the clinic is caught inside a massive garbage bag.
Brown is working in collaboration with the clinic to change that. She put out a call for proposals on how to transform the exterior of the clinic, and will begin work after selecting the final design. In an event Brown organized in collaboration with the New School in New York City, designers shared ideas for walls of lush flora and vegetation and inflatable and interactive sound barriers that add an element of playfulness to an often tense and confrontational zone.
She wants the final design to serve the needs of the clinic and, as she told me when we talked last month, to affirm and support the women who inhabit the space. We talked about the project, what Brown views as a lack of engagement from her field on issues of political relevance, the relationship between the built environment and the patient experience and how space can be playful, beautiful, functional and safe all at once.
Our conversation has been condensed and lightly edited for clarity.
How did this project first come about?
As an architecture student who saw very few women within my academic experience, who was not taught by very many women and did not see very many women in positions of leadership while in practice in New York, I returned to academia [to teach] and thought, It hasn’t really changed that much. Around the same time I began to think about what I could do academically and professionally, my students began to come to me and ask, Why aren’t we learning about more women in our history and theory courses? It prompted me to do something. So part of this project was in response to them.
I had started to look at the domestic space and the relationships between gender and occupation of the home. My experience at a practitioner had been in high end residential and commercial, so I wanted to start taking on subjects that had a far greater impact for the general public. The idea of looking at gendered space and the politics of abortion clinics became a very clear and obvious kind of space to select and study. But honestly, when I began this, I really didn’t know what the trajectory of the project would be. It has expanded in ways that I had never had imagined, which is fantastic.
Originally, I thought that I’d look at my local clinics and try to interview people who go there, who try to get through the protesters. But after receiving a “no” [from those clinics], it forced me to reconsider the scale that I should be looking at. I thought it was really important, but I wasn’t clear yet on how, or why, or what trajectory it would take. As I started to zoom out, I started to realize that it wasn’t only about the clinics, but the states issue, a whole area within the public realm and access points, as being really critical and something that architects should be engaged and talking about. Not only from the design side, but also from the legal side. Who creates building codes, how to become more instrumental in shaping the built environment.
It blossomed into something far greater than what I had originally conceived. Being able to interview all of these providers and owners, to see the experience in different clinics who had worked with architects and designers and see what a difference that made in so many aspects of the experience and the way the practice works. I found that so interesting.
How did you come to work with the Jackson clinic?
When I saw the clinic in Mississippi and interviewed clinic owner Diane Derzis and clinic director Shannon Brewer-Anderson, it was so glaringly obvious that an architect and artists needed to be involved. It made me realize that it can’t just be about Mississippi. This clinic is clearly now the focus, but I can imagine this becoming something where the architects start to work with clinics across the country. But that’s a larger, longer-range potential goal of this.
But right now the focus is on Mississippi’s clinic and what we can do to help create a better experience, actually, for all sides. I think architecture is really instrumental, and should be instrumental, in doing that.
The project feels very collaborative in spirit. It seems like you're working in Mississippi not just because of your interest in the Jackson Women’s Health Organization, but also because of their interest in you.
That’s so true. I think it was also just kindred spirits coming together. When I first met Diane and we started talking, we really hit it off. She has an energy and a fight instinct. She’s not willing to give up. The kind of ordeal that clinic is continuing to go through made it really interesting to me as a potential place to give something.
Once I visited and saw what she was talking about, it became even clearer that either I or someone else had to be involved in making that clinic, that space, that access, better. Aesthetically. Security-wise. Privacy-wise.
And this heightened sense that something has to happen. Things can’t stay the way they are. When I first saw it, fabric was woven through the fence. Just thinking of the women who had to go past that every day -- you want the space to be honoring the decision they made. It just wasn’t acceptable from an architect’s point of view.
The project is about conceptualizing how to use that space, specifically the fence around the clinic. Your approach is open-source, accepting proposals from designers and design students about the possibilities -- both aesthetic and functional -- for the exterior of the clinic. What are some of the ideas that have come through so far?
There were a lot of great ideas that people submitted. There are some that I am really attracted to, but I also feel very strongly that it be something that the clinic and the people who work there have an active voice in. I’ll say what I’m interested in, but I haven’t yet been able to discuss with them at length what has been proposed and what we’re going to do with it. I appreciated some of the submissions that brought humor to it. That’s not to belittle the issue, but there was a sense of playfulness that I think really helped alleviate or minimize the incredible stress that people experience as patients coming in and people who work there.
One that stands out was an inflatable kind of compound. It’s clearly not worked out, but they would be able to monitor noise level and presence level and inflate and deflate as the intensity of protest and noise increased or decreased. The sense would be an almost moving object, an art piece. I really appreciate that there would be a technological aspect to it, a playfulness that engages the arts community that the clinic is located in.
Another one that I liked, and Diane liked too, was just a series of water elements around the clinic. Clearly that’s a kind of crazy idea on one hand, but it would mitigate noise, it would limit visibility, there would be a cooling effect during the hot months of the year. As a conceptual idea, I really loved it. I think water and the sound of water has a restorative and calming effect. I think it would be so interesting to have that placed within the context of this kind of vitriol and sometimes hatred coming from one side of the fence.
Others dealt more with landscape, living and green walls that also had sound-dampening layers within them. Some were very beautiful walls that were sculptural and would really protect the clinic. Not necessarily a castle’s fortress walls, but not that dissimilar conceptually.
One of the things we have to think about, and talk to the clinic about, is how much they want this to participate with the larger community and how much becomes about blocking out the protesters. In a very literal sense. How much is solid and enclosed and how much is about sending out a message to the community -- and to the nation as well -- that there are ways we can do this that are aesthetic and thoughtful but also get at the very serious concerns they have there.
There are such pressing safety and privacy concerns here, obviously.
You look at the security elements, and those are not very nice things to look at or pass by on a regular basis. I especially think of the people who work there every day. I think it would be so much better if we could make the clinic a zone of peacefulness, of security that could make their daily life better.
Abortion clinics are already intensely politicized, but people work in these clinics and others are just there to get essential medical care. They don’t necessarily conceive of themselves as engaged in a political battle when they walk in the door, or at least not every time. Your project is unfolding in collaboration with the Jackson clinic so I don’t see a risk of doing anything that wouldn’t meet their needs, but do you see any possible downside to wanting a design that would further politicize an already contested space?
I think it is a fine line. I think that, without a doubt, it calls it out even further when you do something or propose to do something. But if we have and work with the clinic and the clinic staff and the community and we seek to make it better, I think and hope that then it won’t further politicize it.
The media will do what it does regardless. But if all of the stakeholders are part of the process and have their voices heard, then I can only trust that we will build a place of empowerment, both literally and figuratively. And that would only make it a better place to work or to feel more comfort and ease in daily existence.
But it’s something we are aware of, and work on all the time. So we aren’t capitalizing on it being an issue that is politicized, but solving these problems, but doing it through making space.
We’ve hit such a low in terms of access, and are fighting for small things like getting women in the door, keeping the clinics open. So the secondary conversation about making these spaces beautiful feels almost audacious in a way.
As an architect, so often the conversation gets co-opted by exactly what you’re talking about. Somehow aesthetics and quality of the built environment is never as high on the list. But I so want to argue, and what the project is really trying to do, is to say that it’s not an either/or [between aesthetics and function]. They are completely interdependent. We can’t think of one without thinking of the other.
That’s really one of the larger conversations and issues that the research is really aiming to bring forth. Our build environment, overall, is pretty lousy. We don’t really care about it all that much. We have to start caring far more. Spaces like this, fighting to stay open, the question of what it looks like becomes so minor in that conversation. But I’m trying to help shift it.
Are there policy and planning-oriented answers to these questions about the built environment, the use of space?
More often than not, planning people are at the table when these conversations are happening and decisions are being made. To me, if architects can become more engaged in those discussions that we can help shape and help become more political in what we’re doing.
The book ["Contested Spaces: Abortion Clinics, Women's Shelters and Hospitals"] has been inspired by geographers. Because they are so good at researching and discussing spacialized problems. But they don’t often offer solutions or ideas about how to change it necessarily. The planning, the design field of architecture and even some artists who are doing public space work… I think part of it is taking on political issues and politicized spaces.
You see so few, or fewer, people doing that. I don’t have a direct answer except to encourage more architects, even in a project-by-project basis, to consider being far more politically engaged in the kind of work they accept and the work that they go after. We’ve really distanced ourselves from those discussions, and we have to get back into that if we are going to make a difference in the larger space issues and how the built environment improves.
This reluctance to get involved in the build out or design of an abortion clinic is the same reason that the Jackson clinic struggles to get even basic repair work done. This kind of isolation from the commerce of their community because of people’s desire to avoid a political issue.
What does a space that is safe, accessible and beautiful look like to you?
The outdoor space is critical. What that zone of protection is like. And that’s going to differ from clinic to clinic depending on where they’re located and the different barriers they may be facing in terms of protests. But once you get inside, the things that I notice and thought could be better while I was interviewing people was that the ones that were so great were the ones that really thought about the entrance sequence and what a patient and her support group or partner or friends who come with her would experience when they enter and have to engage with the reception.
Are they having to see through bulletproof glass? Is there a nice, comfortable zone where they don’t feel like they’re being completely watched. What the security looks like. Some people mentioned that they have to wand people down. Others talked about, and I saw, how you have to walk through a metal detector.
Some tried to be less upfront about it, but clearly everyone knows that safety is the of the utmost importance. But I think that what you encounter when you first walk in really sets the tone for what that experience will be like. And those that had waiting rooms with natural light, with comfortable chairs, with enough space for people. Even as you moved back into the procedure rooms and the exam rooms, the kind of space. Are there colors that don’t look so medical or institutional? In the recovery area. What kind of chairs are you reclining in? What’s your relationship to the other patients in the space? Do you have privacy?
These are all not big design things but they make a huge difference in the experience of going through the clinic.
One clinic in particular was so thoughtful in that the doctor made sure, she was one of the ones who worked with an architect, that the patient would not leave through the entrance foyer. So that they had their own private exit so that they didn’t have to go back and be stared at in the waiting room. That gave the patients a private exit out.
And I just thought, That’s a spacial planning issue. And it was so well considered. I just thought, That’s a clear example of how space matters. And how designing these spaces can positively impact a patient’s experience.
When Diane bought the clinic in Jackson, she had to do some work on the roof. Then she decided to completely revamp the colors and some of the finishes on the inside. And it was the one clinic that I went to that you would swear you were not in a clinic. It was yellows and lavenders and red. It was so upbeat. All the way through, from the waiting room to the procedure room to the recovery room.
Investment in these spaces must feel so precarious because the laws shift the goal post over and over and over again. Providers have to ask themselves if the clinic, whatever they invest in the design, will be challenged or shuttered a year from now, two years from now.
I just started looking at research this summer on the ambulatory requirements. I want to compare other medical facilities that do outpatient surgery and what their codes and requirements are compared to abortion clinics and make the case that what they are asking abortion clinics to do is completely not a part of better medical treatment. If you’re going to require abortion clinics to undergo these changes, then you should also be asking dermatology offices and dentist offices to do similar things. I’m tracking through the codes as a way to make the argument.
But you’re right. Why would someone invest thousands of dollars into a design element when you’re not sure if you’re going to be open six months from now?
We have lawyers, doctors, activists bringing this work to the public. Doctors saying that these laws hurt their patients, hurt their practices. Women coming forward to say that they are hurt by these laws. Your project, to me, seems like opening this up for more perspectives. To create a critical mass of people from different specializations and backgrounds to make these arguments within their own fields. To call it out in as many ways as possible.
Absolutely. That is definitely the goal of the research I’m doing right now.
What's the future of the project?
I think this project will be continuing on for a long time in different iterations. But I think of it as trying to hold my discipline more accountable for its lack of involvement and engagement in things like this. It’s critical for the discipline to be more engaged at all of these levels, to help be part of the decision making process.
I just gave a short talk at Provide Access, which is in Cambridge, for their 10-year anniversary of their current executive director. I brought up Women on Waves and how they were so radical when they started to provide services in international waters. And then the recent post-clinic piece in the New York Times about Women on Web. It definitely made me stop and think, Well what role does the clinic play?
As long as the physical clinic is still a mode or point of access, the primary mode of access in this country and others, we’re going to have to continue these discussions and these fights. Until things change. I guess it doesn’t really do much good to say that it’s unfortunate that we’re having these conversations in the 21st century, but until we have more women in positions of power helping to make these decisions and until we have more architects and others engaged in the built environment, things aren’t going to change quickly enough.
What has the response been from your colleagues?
You know, it’s interesting. I’ve gotten support from my institution, for sure. But I’ve found that people outside the discipline, in women and gender studies, in law, in geography, in healthcare, are far more supportive and really see how important the work is. It’s funny because sometimes I feel like I’m the person trying to force the discipline to be more than it is right now.
I’m OK with that. And maybe it takes being at the edge, at the boundaries, to be able to do this kind of work. I’m not sure. I do wish though that there were more people within architecture taking part in this conversation.
When I brought the idea to ArchiteXX, I felt so supported. Within the practice there’s probably more supporters than necessarily within the academics of architecture for this kind of work. In part I guess this speaks to the issue of why this needs to happen with a broader and more diverse public.